Social issues

Some authors have suggested that narcissistic personality disorder is not a psychopathological entity but merely a sociocultural phenomenon related to the contemporary Western 'culture of narcissism'.(89) This approach is probably misleading. Such an explanation may provide a cultural rationalization for some pathological narcissists, but society cannot produce either normal or pathological narcissism as these disorders are complex and are likely to be established during early childhood.(62)

Clinical characteristics and diagnosis

Narcissistic patients seldom approach a psychiatrist, and then usually when depressed or involved in interpersonal problems. The surface functioning of the narcissistic individual may show very little disturbance. However, the inner world of narcissistic patients is extremely pathological, despite their superficially well-adapted behaviour, and this pathology is shown in their self-concept, affectivity, love and sexuality, interpersonal relations and cognitive style. (9.9

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